Privacy

I spend a lot of time thinking about the legal requirements we RMTs have to meet. Then this year, I found myself in a legal situation that required me to assemble my own records from multiple providers, going as far back as 10 years. I had a court order to back me up, but I also knew that I had a legal right to any file in my name if I requested it. After all, that’s the minimum promised by the legal requirements for RMTs and other practitioners written into law, right? 

The situation was serious, I was determined to get the records, and I naively thought it would be a straightforward task.  Because it should be. 

I was on the other side of the “records request” for the first time since I became an RMT, and it opened my eyes to why this is so much more complicated than just assuming I was doing the bare minimum required by privacy law for RMTs. Now I was experiencing the negative consequences of a request not being responded to promptly. I panicked as I realized that I would not be able to get the files I needed and was filled with anxiety as I envisioned the disastrous impact that would have on my court case. 

My Experience Requesting My Own File from a Practitioner Covered by Privacy Law

I experienced a situation where a clinician did not follow the 30 days requirement that PHIPA details. In fact, one agency thought it was acceptable to allow over 100 days to fulfil the file request. The result? I attended a day in court without a very important file. Was I entitled to sue them for breaking privacy law? Yes, but that wasn’t going to help my situation. 

The file request was simply not fulfilled. 

Over and over again, I would be informed there was a fee for requesting the files I needed access to, and each agency happily took that fee. Yet this did not lead to me receiving the file on time. Or in one case, at all. On my last request to that agency, I simply said “I will pay any amount, I absolutely need that file as promptly as you can get it to me”. They responded that I might get it by year’s end when the clinician comes back from her leave of absence. The clinician in me tried to politely remind them that a therapist on leave must leave her files in the hands of an information custodian to allow access to files upon request. Needless to say, this generated no response. They were in breach of privacy laws, and would not release the file. 

As a clinician I was aghast, as a patient who needed this file for court, I was devastated.

For the first time in my 13 years as a clinician, I truly understood why this all matters. File requests should be easy and quick. Most are related to legal matters and represent absolutely grievous damage when they aren’t met. 

These files might document injuries for an insurance claim, but might just as easily outline evidence of spousal or child abuse. 

How we chart and the level of detail in our notes is our choice as a clinician, but the details in the files we keep belong first and foremost to our patients. 

If this changes the conversation on charting a bit, it asks us as RMTs to consider why we chart, what information should be included. 

I understand more than ever why “the right of the patient” matters, including the following of legal requirements for health professionals, including RMTs

I have had a client disclose during treatment that they had just fled abuse and would prefer a body part to not be included in the massage. Would all clinicians include that detail in their files? I feel strongly that we should. There may be no reason to report to a third party agency, after all the abuse has finished, no one is at risk. But by putting that in the patient’s file, and having it available that full 10 years might mean that abuse survivor can prove she/he did speak about abuse to their clinician. 

Is this beyond the minimum legal requirement for RMTs? Certainly. But my experience being frustrated in my need to access my own files with a clinician, and in a timely fashion, has made me appreciate how absolutely important this is. Not from simply from a clinician perspective, but from a human perspective. 

If keeping detailed files is important, having access to a note section for subjective and objective information is equally pressing. We are clinicians tasked with the care of one facet of a patient’s care. But if we do this task well, we are helping to ensure that that person, that human being, not only gets great care in that moment, but continues to receive great care at the time of a file request.  

This could be at a time when they are the most stressed, when being tasked with the extra step of advocacy to simply access their information is especially burdensome. Easily and quickly…this is absolutely crucial. It is vital to a person in a legal matter, because they likely have so many other facets of that situation to struggle with, not getting their files easily or quickly should not be something they have to navigate. Good record keeping should be the very bare minimum promised by every single clinician in health care. Anything less undermines our patients’ care and our practices. Anything less is unacceptable. 

How we manage our files and requests for copy of files matters. It matters that we commit to do more than the legal minimum. It matters that we commit to the full care of the people who trust their care to our hands.